Hannan Research Shows that Risk Factors Predict Patient Survival
and Ability to Function After Hip Fracture
Contact: Vincent Reda, 518-437-4985
Risk factors, including age and residency in a nursing home, can help
predict how well a patient will be able to function after breaking a
hip, while other risk factors can help predict whether patients will
survive a hip fracture, according to an article by UAlbany Professor
Edward L. Hannan in the June 6 issue of The Journal of the American
Medical Association (JAMA).
Hannan, chair of the Department of Health Policy, Management, and Behavior
in UAlbany's School of Public Health, and his colleagues analyzed data
on 571 adults, aged 50 and older, who experienced hip fractures and
were admitted to four hospitals in New York City between August 1997
and August 1998.
The study, with Hannan as principal investigator, was designed to identify
and compare the importance of significant pre-fracture predictors of
functional status and mortality at six months, and to compare risk-adjusted
outcomes for hospitals providing initial care.
Hip fracture is a common cause of death and disability. According to
background information cited in the article, an estimated 350,000 hip
fractures occur each year in the U.S., and the total inpatient cost
of caring for these patients is nearly $6 billion per year, exclusive
of physician charges. Among patients discharged following hospitalization
for hip fracture, only 60 percent will have recovered their pre-fracture
walking ability by six months, and 24 percent of patients will have
died by 12 months.
Recognizing a need exists for a practical means to monitor and improve
outcomes, including function, for patients with hip fractures, the authors
focused on the death rate (in the hospital and at six months), locomotion
(the patient's ability to walk and climb stairs), and adverse outcomes
- death, or the patient's need for total assistance to move around.
The results were compared by hospital, and adjusted for patient risk
factors. Patient risk factors prior to the fracture included age, sex,
race, functional status, dementia, admission from a nursing home, and
whether a paid helper was required to care for the patient. A modified
APACHE (Acute Physiology and Chronic Health Evaluation) score was used
to capture the impact of patients' vital signs, laboratory studies,
and mental status, and a modified comorbidity score measured the impact
of chronic conditions.
"The in-hospital mortality rate was 1.6 percent," writes Hannan. "At
six months, the mortality rate was 13.5 percent, and another 12.8 percent
[of patients] needed total assistance to ambulate. Laboratory values
were strong predictors of mortality but were not significantly associated
with locomotion. Lower pre-fracture locomotion, a higher modified APACHE
score, and a paid helper at home prior to the fracture were significantly
related to higher mortality at six months.
"Age and pre-fracture residence at a nursing home were significant
predictors of locomotion, but were not significantly associated with
mortality," the authors continue.
With respect to hospital performance, the study found that performance
on one outcome was not necessarily related to performance on another.
"This indicates that both mortality and functional status measures are
needed to adequately assess hospital performance, and that the processes
of care that are associated with lower mortality rates are not identical
to the processes associated with better functional status," the authors
Hannan and his colleagues suggest that their findings have implications
for ongoing efforts by clinicians, hospitals, accrediting agencies,
employers, and other parties to better understand and improve outcomes
of health care. "Specifically, we believe that greater attention needs
to be paid, not only to preventing hip fracture, but also to preventing
the mortality and morbidity that results once a patient has fractured
a hip - an issue that has not been on the quality improvement agenda
of most health care organizations."
The authors encourage more clinical research to better understand the
efficacy of interventions that might increase survival and improve functional
This project was supported by grants from the Agency for Healthcare
Research and Quality, the Mary and David Hoar Fellowship of the New
York Community Trust and the New York Academy of Medicine, the National
Institute on Aging, and the American Federation for Aging Research Paul
Beeson Faculty Scholar Award.
For more University at Albany information, visit our World Wide Web
site at http://www.Albany.edu.
June 5, 2001
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